Detailed Information

NPI Number 1427005008 has the “Organization” type of ownership and has been
registered to the following primary business legal name (which is a provider name or healthcare organization name) — EMERGENCY COVERAGE CORP .
The enumeration date of this NPI Number is 05/28/2006.
NPI Numer information was last updated at 01/29/2015.

Provider's other registered legal business name is EMERGENCY COVERAGE CORPORATION OF TEAMHEALTH .

The provider is physically located (Business Practice Location) at:

435 2ND ST
NEWPORT
, TN
37821-3703
US

The provider can be reached at his practice location using the following numbers:

Phone 423-625-2200Fax

The provider's official mailing address is:

PO BOX 636019
CINCINNATI
, OH
45263-6019
US

The contact numbers associated with the mailing address are:

Phone Fax

The authorized official registered with the “1427005008” NPI Number
is
DR.
ROGER
A.
BROOKSBANK
.

The authorized official title (position) is PRESIDENT.

You can reach the authorized official at the following phone number 865-693-1000.

Scope of Practice

The following information about the specialty of the provider is available:

#

Taxonomy Code

Taxonomy

License Number

License Number State

1

208M00000X

Hospitalist

TN

2

208M00000X

Hospitalist

GA

3

207Q00000X

Family Medicine

4

207R00000X

Internal Medicine

5

207P00000X

Emergency Medicine

TN

Legacy Identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

The "Is the organization a subpart?" question must be answered. If the organization is a subpart, the Parent Organization Legal Business Name (LBN) and Parent Organization Taxpayer Identification Number (TIN) fields must be completed. The Parent Organization LBN and TIN fields can only be completed if the answer to the subpart question is Yes.
Many organization health care providers who apply for NPIs are not legal entities themselves but are parts of other organization health care providers that are legal entities (the "parents").
Here are three examples of organization health care providers that may be considered subparts and may apply for NPIs if so directed by their "parents":
(1) The psychiatric unit in a hospital is not a legal entity but is part of the hospital (the "parent"), which is a legal entity. The legal entity must obtain an NPI. The psychiatric unit is an example of a subpart that could have its own NPI if the hospital determines that it should.
(2) A group practice that is not a sole proprietorship has a main location and could have other offices in different locations, but each office is not a separate legal entity; instead, each office is part of the corporation (the "parent") which is a legal entity. The offices are examples of subparts that could have their own NPIs if the main location determines that they should.
(3) A pharmacy fills prescriptions for patients whose physicians have prescribed medications for them and may also rent or sell durable medical equipment to patients whose physicians have ordered such equipment for them. Neither the pharmacy line of business nor the DME line of business represent legal entities; instead, both lines of business are part of an organization (the "parent") that is a legal entity. Each line of business represents a different Healthcare Provider Taxonomy or area of specialization that often submits its own electronic claims to health plans.
The "parent"-we don't know who the parent is in this example-must ensure that each subpart that submits its own claims to health plans has its own NPI.

4

Provider Organization Name (Legal Business Name)

EMERGENCY COVERAGE CORP

Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.

The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''.

8

Provider Business Mailing Address City Name

CINCINNATI

The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''.

9

Provider Business Mailing Address State Name

OH

The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''.

10

Provider Business Mailing Address Postal Code

45263-6019

The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''.

11

Provider Business Mailing Address Country Code

US

The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''.

12

Provider First Line Business Practice Location Address

435 2ND ST

The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

13

Provider Business Practice Location Address City Name

NEWPORT

The city name in the location address of the provider being identified.

14

Provider Business Practice Location Address State Name

TN

The State or Province name in the location address of the provider being identified.

15

Provider Business Practice Location Address Postal Code

37821-3703

The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.

16

Provider Business Practice Location Address Country Code

US

The country code in the location address of the provider being identified.

17

Provider Business Practice Location Address Telephone Number

423-625-2200

The telephone number associated with the location address of the provider being identified.

18

Provider Enumeration Date

05/28/2006

The date the provider was assigned a unique identifier (assigned an NPI).

19

Last Update Date

01/29/2015

The date that a record was last updated or changed.

20

Authorized Official Last Name

BROOKSBANK

The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.

21

Authorized Official First Name

ROGER

The first name of the authorized official

22

Authorized Official Middle Name

A.

The middle name of the authorized official

23

Authorized Official Title or Position

PRESIDENT

The title or position of the authorized official

24

Authorized Official Name Prefix Text

DR.

Authorized Official Name Prefix Text

25

Authorized Official Credential Text

M.D.

Authorized Official Credential Text

26

Authorized Official Telephone Number

865-693-1000

The 10-position telephone number of the authorized official.

27

Healthcare Provider Taxonomy Code #1

208M00000X

The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.

28

Healthcare Provider Taxonomy 1

Hospitalist

Healthcare Provider Taxonomy #1

29

Provider License Number State Code 1

TN

Provider License Number State Code #1

30

Healthcare Provider Primary Taxonomy Switch 1

N

Primary Taxonomy:

X - The primary taxonomy switch is Not Answered;

Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);

N - The taxonomy is not the primary taxonomy.

31

Healthcare Provider Taxonomy Code 2

208M00000X

Healthcare Provider Taxonomy Code #2

32

Healthcare Provider Taxonomy 2

Hospitalist

Healthcare Provider Taxonomy #2

33

Provider License Number State Code 2

GA

Provider License Number State Code #2

34

Healthcare Provider Primary Taxonomy Switch 2

N

Primary Taxonomy:

X - The primary taxonomy switch is Not Answered;

Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);

N - The taxonomy is not the primary taxonomy.

35

Healthcare Provider Taxonomy Code 3

207Q00000X

Healthcare Provider Taxonomy Code #3

36

Healthcare Provider Taxonomy 3

Family Medicine

Healthcare Provider Taxonomy #3

37

Healthcare Provider Primary Taxonomy Switch 3

N

Primary Taxonomy:

X - The primary taxonomy switch is Not Answered;

Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);

N - The taxonomy is not the primary taxonomy.

38

Healthcare Provider Taxonomy Code 4

207R00000X

Healthcare Provider Taxonomy Code #4

39

Healthcare Provider Taxonomy 4

Internal Medicine

Healthcare Provider Taxonomy #4

40

Healthcare Provider Primary Taxonomy Switch 4

N

Primary Taxonomy:

X - The primary taxonomy switch is Not Answered;

Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);

N - The taxonomy is not the primary taxonomy.

41

Healthcare Provider Taxonomy Code 5

207P00000X

Healthcare Provider Taxonomy Code #5

42

Healthcare Provider Taxonomy 5

Emergency Medicine

Healthcare Provider Taxonomy #5

43

Provider License Number State Code 5

TN

Provider License Number State Code #5

44

Healthcare Provider Primary Taxonomy Switch 5

Y

Primary Taxonomy:

X - The primary taxonomy switch is Not Answered;

Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);

N - The taxonomy is not the primary taxonomy.

45

Other Provider Identifier 1

7100001620

Other Provider Identifier #1

46

Other Provider Identifier Type 1

MEDICAID

Other Provider Identifier Type #1

47

Other Provider Identifier State 1

KY

Other Provider Identifier State #1

48

Other Provider Identifier 2

DE2714

Other Provider Identifier #2

49

Other Provider Identifier Type 2

MEDICARE PIN

Other Provider Identifier Type #2

50

Other Provider Identifier State 2

KY

Other Provider Identifier State #2

51

Other Provider Identifier 3

DD1132

Other Provider Identifier #3

52

Other Provider Identifier Type 3

MEDICARE PIN

Other Provider Identifier Type #3

53

Other Provider Identifier State 3

VA

Other Provider Identifier State #3

54

Other Provider Identifier 4

C09459

Other Provider Identifier #4

55

Other Provider Identifier Type 4

MEDICARE PIN

Other Provider Identifier Type #4

56

Other Provider Identifier State 4

VA

Other Provider Identifier State #4

57

Other Provider Identifier 5

000000061568

Other Provider Identifier #5

58

Other Provider Identifier Type 5

OTHER

Other Provider Identifier Type #5

59

Other Provider Identifier State 5

KY

Other Provider Identifier State #5

60

Other Provider Identifier Issuer 5

ANTHEM BCBS KY

Other Provider Identifier Issuer #5

61

Other Provider Identifier 6

529930860

Other Provider Identifier #6

62

Other Provider Identifier Type 6

MEDICAID

Other Provider Identifier Type #6

63

Other Provider Identifier State 6

AL

Other Provider Identifier State #6

64

Other Provider Identifier 7

CA5359

Other Provider Identifier #7

65

Other Provider Identifier Type 7

MEDICARE PIN

Other Provider Identifier Type #7

66

Other Provider Identifier State 7

TN

Other Provider Identifier State #7

67

Other Provider Identifier 8

9559

Other Provider Identifier #8

68

Other Provider Identifier Type 8

MEDICARE PIN

Other Provider Identifier Type #8

69

Other Provider Identifier State 8

KY

Other Provider Identifier State #8

70

Other Provider Identifier 9

C09877

Other Provider Identifier #9

71

Other Provider Identifier Type 9

MEDICARE PIN

Other Provider Identifier Type #9

72

Other Provider Identifier State 9

VA

Other Provider Identifier State #9

73

Other Provider Identifier 10

DD0983

Other Provider Identifier #10

74

Other Provider Identifier Type 10

MEDICARE PIN

Other Provider Identifier Type #10

75

Other Provider Identifier State 10

GA

Other Provider Identifier State #10

76

Other Provider Identifier 11

65922783

Other Provider Identifier #11

77

Other Provider Identifier Type 11

MEDICAID

Other Provider Identifier Type #11

78

Other Provider Identifier State 11

KY

Other Provider Identifier State #11

79

Other Provider Identifier 12

GRP2049

Other Provider Identifier #12

80

Other Provider Identifier Type 12

MEDICARE PIN

Other Provider Identifier Type #12

81

Other Provider Identifier State 12

GA

Other Provider Identifier State #12

82

Other Provider Identifier 13

611075400

Other Provider Identifier #13

83

Other Provider Identifier Type 13

OTHER

Other Provider Identifier Type #13

84

Other Provider Identifier State 13

TN

Other Provider Identifier State #13

85

Other Provider Identifier Issuer 13

USDLAB

Other Provider Identifier Issuer #13

86

Other Provider Identifier 14

65938623

Other Provider Identifier #14

87

Other Provider Identifier Type 14

MEDICAID

Other Provider Identifier Type #14

88

Other Provider Identifier State 14

KY

Other Provider Identifier State #14

89

Other Provider Identifier 15

611075400

Other Provider Identifier #15

90

Other Provider Identifier Type 15

OTHER

Other Provider Identifier Type #15

91

Other Provider Identifier State 15

GA

Other Provider Identifier State #15

92

Other Provider Identifier Issuer 15

US DEPT OF LABOR

Other Provider Identifier Issuer #15

93

Other Provider Identifier 16

3728413

Other Provider Identifier #16

94

Other Provider Identifier Type 16

MEDICARE UPIN

Other Provider Identifier Type #16

95

Other Provider Identifier State 16

TN

Other Provider Identifier State #16

96

Other Provider Identifier 17

3728413

Other Provider Identifier #17

97

Other Provider Identifier Type 17

MEDICAID

Other Provider Identifier Type #17

98

Other Provider Identifier State 17

TN

Other Provider Identifier State #17

99

Other Provider Identifier 18

5906246

Other Provider Identifier #18

100

Other Provider Identifier Type 18

MEDICAID

Other Provider Identifier Type #18

101

Other Provider Identifier State 18

NC

Other Provider Identifier State #18

102

Healthcare Provider Taxonomy Group 1

193200000X MULTI-SPECIALTY GROUP

Healthcare Provider Taxonomy Group 1

103

Healthcare Provider Taxonomy Group Description 1

Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization.

Healthcare Provider Taxonomy Group Description 1

104

Healthcare Provider Taxonomy Group 2

193200000X MULTI-SPECIALTY GROUP

Healthcare Provider Taxonomy Group 2

105

Healthcare Provider Taxonomy Group Description 2

Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization.

Healthcare Provider Taxonomy Group Description 2

106

Healthcare Provider Taxonomy Group 3

193200000X MULTI-SPECIALTY GROUP

Healthcare Provider Taxonomy Group 3

107

Healthcare Provider Taxonomy Group Description 3

Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization.

Healthcare Provider Taxonomy Group Description 3

108

Healthcare Provider Taxonomy Group 4

193200000X MULTI-SPECIALTY GROUP

Healthcare Provider Taxonomy Group 4

109

Healthcare Provider Taxonomy Group Description 4

Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization.

Healthcare Provider Taxonomy Group Description 4

110

Healthcare Provider Taxonomy Group 5

193200000X MULTI-SPECIALTY GROUP

Healthcare Provider Taxonomy Group 5

111

Healthcare Provider Taxonomy Group Description 5

Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization.